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NHS continuing care

Busterpen

Registered User
Oct 27, 2013
51
Mum is currently in a nursing home has alzheimers, chronic kidney disease, osteoporosis,cardiomyopathy and hypertension. She has lost her appetite and is being given liquid food. Needs help dressing. Has anyone on here apply for nhs continuing care. On her assessment when she was in hospital it wasn't applicable but now she seems to have detiorated. Is it worth applying or not
 

Saffie

Registered User
Mar 26, 2011
22,507
Near Southampton
Hello and welcome to TP. I hope you'll find help and support here.
It is certainly worth applying for CHC funding, just don't get your hopes too high.
The information about it you will find here
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=399

There are a lot of threads on here about this process, some more positive than others. There are so many that it would probably be better if you search 'CHC funding' in 'Search Talking Point' which can be found at the top RH corner of this page. These will give you an idea of the difficulty of gaining this funding. good luck!
 

fr0d0

Registered User
Dec 23, 2009
186
Mid Wales
Hi and welcome bustapen

If your mum needs care because of illness, accident or disease then she is entitled to free care from the NHS. Should that care have to cover all of her needs, whether or not those needs can be met by ancillary staff or qualified nurses, makes no difference... the NHS has to pay, by law.

The NHS have a process in place to prevent your mum receiving what she is legally entitled to, called the CHC framework. The NHS has been challenged in law continually over the years and judges have ruled in favour of patients and against the CHC framework judging it to be unlawful.

Apply, and if you're refused, stick to the law. Don't let them get away with it.
 
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Yellow Diamond

Registered User
Dec 28, 2013
7
CHC (Continuing Health Care) or FNC (Funded Nursing Care)

Hi and welcome bustapen

If your mum needs care because of illness, accident or disease then she is entitled to free care from the NHS. Should that care have to cover all of her needs, whether or not those needs can be met by ancillary staff or qualified nurses, makes no difference... the NHS has to pay, by law.

The NHS have a process in place to prevent your mum receiving what she is legally entitled to, called the CHC framework. The NHS has been challenged in law continually over the years and judges have ruled in favour of patients and against the CHC framework judging it to be unlawful.

Apply, and if you're refused, stick to the law. Don't let them get away with it.
Hello,

I have helped a friend go through this Continuing Health Care application process which is very stressful for the carer/relative and time consuming and very expensive for the NHS. Sitting through hours of questions and form filling - but despite Nursing Home staff, Social Services staff and NHS staff trying to put you off - DO NOT BE PUT OFF.

If the patient does not qualify for Continuing Health Care (where the NHS take over funding from Social Services) they may well qualify for Funded Nursing Care (about £109.00 per week). This then puts them into the system where any worsening of their condition can mean a further assessment may be carried out. This should be at least every three months. At some stage the patient may well qualify for Continuing Health Care which will mean that Social Services cease involvement and all care is funded by the NHS, not just the nursing element.

There are specialist solicitors which I bellieve I cannot mention, who will provide you with a copy of the Checklist which is used to grade the severity of the patient's illness. These solicitors will look at a completed checklist for you. We did not have to do that as we just went through the checklist they supplied and realised that CHC would not be awarded at this point, but insisted that the patient was assessed and this resulted in the Funded Nursing Care being awarded.

At some point in the future a further assessment will very probably reveal that Continuing Health Care is appropriate.

The patient IS ENTITLED to have an assessment of his/her care needs. The application can be made by the Nursing Home at your request - you will probably find the GP very helpful also.

Best wishes for your success.
 

Mike2

Registered User
Sep 7, 2012
1
Mike 2

The answer to your question,Bustapen, is that your mother is undoubtedly entitled to NHS CHC assessment and I would guess that despite the condition that you describe the maxi that you will be given,or rather will be paid to the Care Home is £109.79 per week towards Nursing Care.
As somebody who has extended and agonising experience of going through the process of Assessment,Reviews and the DST on behalf of a relative I an assure you that no matter what the scores ascribed to your mother in the relevant domains it will make little difference and Why;Government or NHS legal draftsmen have devised an ingenious concept described as "Primary Health Care Need" comprised of four elements "Nature,Intensity,Complexity and Unpredictability" which are used to fudge the process and to assure the reader that no matter how severe or high the llevel of need of the patient the needs are only social.The whole process is a farce and an outrage being actively brushed under the carpet by the Dept of Health and staffed by well paid senior nursing staff of the NHS. The term Primary Health Care Needs" has no legal basis whatsoever.You will almost certainly need to go through the process to get the Nursing Care and then if you feel that the recommendations are wrong go to lawyers on a pay by results basis.Sadly we are up against a monster and there is no alternative distressing though it may be.
I would like to hear more from the Alzheimer's Society who do not seem to have been the rallying point for action that one would have hoped.
 

blandford516

Registered User
May 16, 2012
262
Hi mike ,

I must say well put .It is exactly what we have experienced , but my mums case is now with solicitors .

Busterpen,

Please apply for Continious Care as your case certaintly say fits the criteria .Best of luck x
 

ohno!

Registered User
Nov 16, 2013
103
This is what I thought but my mums SW thinks mum will get NHS CHC without any problem!! My mum has been stuck in an assessment hospital for over 3 months two of which her SW has been doing ever thing to NOT to get mum placed, he has now decided that given the assessment centre recommend that mum needs dementia nursing care the NHS should pay for it via CHC!!!
 

fr0d0

Registered User
Dec 23, 2009
186
Mid Wales
There are specialist solicitors which I bellieve I cannot mention, who will provide you with a copy of the Checklist which is used to grade the severity of the patient's illness. These solicitors will look at a completed checklist for you. We did not have to do that as we just went through the checklist they supplied and realised that CHC would not be awarded at this point, but insisted that the patient was assessed and this resulted in the Funded Nursing Care being awarded.

At some point in the future a further assessment will very probably reveal that Continuing Health Care is appropriate.
No need for a solicitor to do that. You can do it yourself... those unlawful documents are freely available from the NHS. You can choose to waste your time trying to satisfy those criteria, but why? Just challenge the whole thing for what it is: unlawful.

The professionals: doctors, nurses, care home managers, social workers etc need us to educate them on the illegality of their training. Show them the quotes from law lords saying that the chc framework is a scam. Show them lord Wolfe's guidance that all assessments should be made against Pamela Coughlans case and hand them Pam's signed daily routine and medical requirements.

My mum has a terminal disease. The CHC assessment is scoring less every time she's assessed. Her increasingly weakened state means she is easier to manage: Her medical care can be provided with less specialist intervention. This is an abomination... the law states that her illness has to be paid for by the NHS. The insurance we pay for to cover such an outcome.
 

Wirralson

Account Closed
May 30, 2012
658
Fr0d0

Do you have the reference for the law report on the Coughlan case? I'm not sure that it rules that the CHC framework itself is unlawful, but that the application of it in that case was. But I'd be interested to read the judgment itself.

Kind regards

Wirralson
 

geum123

Registered User
May 20, 2009
4,604
Fr0d0

Do you have the reference for the law report on the Coughlan case? I'm not sure that it rules that the CHC framework itself is unlawful, but that the application of it in that case was. But I'd be interested to read the judgment itself.

Kind regards

Wirralson
In the back of my mind, (and I may be wrong,) but I think the CHC framework came after the Coughlan case???
 

crazyfish

Registered User
Oct 12, 2012
288
This is what I thought but my mums SW thinks mum will get NHS CHC without any problem!! My mum has been stuck in an assessment hospital for over 3 months two of which her SW has been doing ever thing to NOT to get mum placed, he has now decided that given the assessment centre recommend that mum needs dementia nursing care the NHS should pay for it via CHC!!!
Hi,
Unfortunately health care and it's provision has absolutely nothing to do with your mums SW.
They are not qualified to pass any judgement on if someone will receive CHC or not.
Their only responsibility is to assist you any way they can.
Ask at the hospital to speak to the CHC co ordinator and get a full CHC assessment done ASAP.
Mick
 

Wirralson

Account Closed
May 30, 2012
658
I think the CHC national framework was introduced in 2007 but that local implementations existed before that.
Nitram is correct. The current national framework and associated training was introduced in 2007. It has been revised at least once to my knowledge. It postdates Coughlan and was in part a response to it.
 

Wirralson

Account Closed
May 30, 2012
658
In the back of my mind, (and I may be wrong,) but I think the CHC framework came after the Coughlan case???
My suspicion was that the present CHC framework wasn't involved in the Coughlan case which hinged in part on a decision to close a specific care home - Mardon House - and undertakings given to those residents who had been moved there from another one - Newcourt. Re-reading the report of the judgment confirms this.
 

SisterAct

Registered User
Jul 5, 2011
2,255
67
Liverpool, Merseyside
Here is the link for the up to date CHC forms.
The 'checklist' is completed first and if a person 'triggers' then a full CHC assessment is carried out.
Gathering evidence plays a crucial part in this process and the family should be encouraged to assist with this (this doesn't always happen:rolleyes:).

We kept a diary of Dads dementia journey and this was actually used as evidence by his Community Matron at the assessment. We recorded, falls, changes in meds, hospital visits, chest infections, water infections etc.

Hope this helps
Polly x


https://www.gov.uk/government/publi...inuing-healthcare-and-nhs-funded-nursing-care
 

geum123

Registered User
May 20, 2009
4,604
My suspicion was that the present CHC framework wasn't involved in the Coughlan case which hinged in part on a decision to close a specific care home - Mardon House - and undertakings given to those residents who had been moved there from another one - Newcourt. Re-reading the report of the judgment confirms this.
Hi Wirralson,:)

I don't believe the framework was in existence in the Coughlan Case, but maybe it came about afterwards as a means to determine who should be funded by the NHS.
Of course, it is a post code lottery and the DST is "open to interpretation" which of course gives plenty of scope to say NOT ELIGIBLE.

http://www.wales.nhs.uk/sitesplus/866/opendoc/180025
The Coughlan Judgment, the Grogan Judgment, and St. Helens Judgement.

If you scroll down to page 56 you can see how the Coughlan case and others are used in context of who pays for what, (Nhs v Social) and as such, the Health boards obviously must take into consideration such cases.


I wrote to the Welsh assembly and was told that they were Coughlan compliant.;)

Is the framework legal? ...... Well I'm not law savvy.

I personally think you have to work with the framework, because the only way of challenging its legality would be, I imagine in court, and you may need plenty of Spondoolies for that.:eek::rolleyes:
 
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Wirralson

Account Closed
May 30, 2012
658
Geum 123

Many thanks - it confirms my earlier post. I agree with your final conclusion. The Coughlan judgment makes clear that the NHS has a degree of discretion in deciding what is and isn't required by way of nursing care. The Grogan case is the one which resulted in what had previously been guidance only being developed into the mandatory national CHC framework. (The issue was partly that there was no evidence of how the decision to decline CHC funding had been reached or what criteria employed.) The St Helens case makes it clear that the NHS (then the PCTs now CCGs) is the primary decision taker as to what is a primary health need The question at issue seems to have been how that discretion was exercised in that particular case, especially given the background of undertakings given to residents of the care homes in question. The definition of "nursing care" would also appear to be an issue. The NHS regards nursing care as quite specifically requiring the care of someone with nursing qualifications, which in many cases dementia patients will not need on a day to day basis. Incidentally, although the colloquial references are frequently is to "Coughlan compliance" the Grogan case (sometimes called the Bexley case) and the St Helens and Knowsley case equally relevant to the point at discussion in this thread, The point is that the Coughlan case makes clear that there is a discretion as to what constitutes nursing care. The Grogan case makes it clear there needs to be evidence of the basis for the decision. That case was a judicial review and it is as well to remember the remedies are limited - in effect if the public authority loses, they have to go back and consider their decision in the light of the judgment, but the issue is often how a decision was reached rather than the decision itself. The Grogan cases resulted in the mandating of the national CH framework, although guidance (based on the reasoning in the Coughlan case), appears to have existed before that. Finally the St Helens case makes clear that the decision on what constitutes a primary health need rested with what were Primary Care Trusts in England and are now Clinical Commissioning Groups. So I'd say anyone arguing that the CHC framework is, of itself, unlawful is making a statement that is difficult to support. Implementation of it and decisions in individual cases may be open to challenge, but that would require professional advice.

One the question of legality, my understanding is that the NHS and Community Care Act 1990 and the NHS Act 2006 are as Acts of Parliament, lawful (although European law can override these to an extent). Challenging the lawfulness of aspects of its implementation (i.e. on the subject here, the use of CHC framework, or the latter's implementation in any given case) would almost certainly need to be by way of judicial review. That has strict time limits, and is, as you point out, potentially extremely costly. Mounting such a legal challenge would require expert professional advice from a solicitor specialising in the field.

I'd also agree strongly with you that anyone seeking CHC funding for a relative is going to get best results working within the framework and trying to influence the outcome by engaging with it, as SisterAct illustrates. The NHS will use it - so individuals might as well work with the tools they have. Brandishing a copy of the Coughlan judgment and claiming the whole process is unlawful isn't going to help - the NHS staff will politely ignore any remarks to that effect and simply complete the CHC assessment regardless.

Wirralson
 
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Tottz

Registered User
Jan 25, 2014
7
Hampshire
Hi,
Unfortunately health care and it's provision has absolutely nothing to do with your mums SW.
They are not qualified to pass any judgement on if someone will receive CHC or not.
Their only responsibility is to assist you any way they can.
Ask at the hospital to speak to the CHC co ordinator and get a full CHC assessment done ASAP.
Mick
Hi,
We have recent experience of this, a couple of weeks ago whilst Mum in-law was in hopsital we asked the hospital and the s/w to have an assessment done. Both reassured us that all patients - ie elderly with dementia & other health issues, were automatically assessed.
When we asked for a copy of the assessment on her released they hadn't done one as she wasnt in hospital long enough! (she was in for a week after a UTI & suspected TAI).
We had the sw out to us yesterday because we were are not happy with the level of home care provided and asked again about the assessment and were told that she didn't fit the criteria!
I have been told by other health care professionals to make sure that every problem, crisis is logged - by calling 111 or her doctor so that there will then be a history building.
 

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